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Pennsylvania rates for HCPCS 40702

Plstc Rpr Cl Lip/Nsl Dfrm Prim Bi 1 2 Stgs

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,054.52 / $3,748.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.66 / $987.54 / $1,225.48
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.24 / $1,036.95 / $1,036.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.47 / $1,084.08 / $1,830.51
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.38 / $1,536.92 / $1,590.73
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $3,964.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.38 / $1,119.00 / $5,287.32
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.80 / $1,040.80 / $1,092.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,127.85 / $1,127.85 / $1,127.85
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$867.78 / $1,106.41 / $1,954.77
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$962.13 / $974.77 / $974.77
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$962.13 / $974.77 / $1,031.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,843.00 / $3,879.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.18 / $1,100.82 / $1,904.32